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Comparison of Endoscopic Dacryocystorhinostomy with Mitomycin C versus without Mitomycin C for Nasolacrimal Obstruction: A Meta-Analysis

Objective　To systematically review the effectiveness of endoscopic dacryocystorhinostomy (En-DCR) with versus without Mitomycin C (MMC) for nasolacrimal obstruction. Methods　Databases such as PubMed, EMbase, CENTRAL (Issue 12, 2012), VIP, WanFang Data, CBM and CNKI were electronically searched to collect the randomized controlled trials (RCTs) which investigated the comparison between En-DCR with and without MMC for nasolacrimal obstruction. The searched data was updated to December 31st, 2012. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of the included studies was also assessed. Then, meta-analysis was performed using RevMan 5.2.0 software and the quality of evidences was graded using GRADEpro 3.6 software. Results　A total of 9 RCTs were included in the meta-analysis. The results of meta-analysis showed that, the recovery rate in the MMC group was significantly elevated (RR=1.13, 95%CI 1.04 to 1.22, P=0.003), the area of ostium in the MMC group was bigger at 1, 6 and 12 months than in the control group, postoperatively (MD=6.68 mm2, 95% 5.43 to 7.94, Plt;0.000 01; MD=11.61 mm2, 95%CI 4.67 to 18.55, P=0.001; MD=15.65 mm2, 95%CI 2.95 to 28.34, P=0.02), respectively, but the area of ostium in the MMC group at the third month was bigger than that in the control group (MD=8.20 mm2, 95%CI –6.67 to 23.08, P=0.28). The operative time was significantly prolonged in the MMC group (MD=10.1 min, 95%CI 8.00 to 12.20, Plt;0.000 01). Conclusion　En-DCR combined with MMC could improve the recovery rate and prevent the over shrinkage of ostium area effectively due to nasolacrimal obstruction.

CT of Inverted Papilloma in the Nasal Cavity and Nasal Sinuses

目的：着重探讨鼻腔及鼻窦内翻性乳突状瘤CT表现特征及诊断价值。材料和方法：收集经手术和病理确诊的鼻腔及鼻窦内翻性乳突状瘤65例CT资料，进行回顾性研究。结果：65例IP的CT表现特征，以鼻中道为中心的一侧鼻窦和/或鼻腔内不规则软组织肿块。其中，仅鼻腔受累者18例，一侧鼻腔及鼻窦均受累者47例。鼻腔及鼻窦有膨大并骨质破坏者43例。软组织肿块强化者23例。术后IP复发者13例（20%）；恶变者9例（14.3%）。结论：CT检查对IP的病变部位、范围、程度等能准确确定，可为手术治疗提供重要依据。

Etiology and Treatment of Re-Blockage after Dacryocystorhinostomy

【摘要】 目的 探讨泪囊鼻腔吻合术后复发的原因和手术方法。 方法 对1999年1月-2009年10月因泪道阻塞行泪囊鼻腔吻合术后3个月以上复发的47例患者，行再吻合术，术中仔细分离切除瘢痕及肉芽，尽量做双瓣吻合。 结果 本组50只眼，术后随访3个月～2年，成功49只眼，1例再阻塞，治愈率98%。 结论 首次手术失败的主要原因是骨孔过小，吻合口粘连，泪囊太小或萎缩，解剖层次不清和手术操作粗暴导致术中出血等。再次吻合手术治疗效果满意。【Abstract】 Objective To explore the reasons of recurrence and the operative method for re-blockage after dacryocystorhinostomy. Methods Forty-seven patients with dacryocystorhinostomy who were recurred after 3 months were included from January 1999 to October 2009. All patients underwent re-anastomosis. The operation required careful separation and resection of scar and granulation, and performed anastomosis with double valve as far as possible. Results All patients were followed up for three months to two years. Operations were successful in 49 eyes of total 50 eyes, and re-obstruction in one case with a cure rate of 98%. Conclusion The major reasons for the failure of the first operation include too small bone hole, anastomotic adhesions, too small or atrophy of lacrimal sac, unclear anatomy and surgical gross bleeding. The best treatment is surgical re-anastomosis.

Nasal Endoscopic in the Treatment of Nasal Inverted Papilloma

目的：探讨鼻内镜手术治疗鼻内翻性乳头状瘤(NIP)的疗效。方法：回顾性分析用鼻内镜手术治疗的36例经病理确诊的NIP患者的临床资料，随访1～6年。结果:”一次性治愈31例(86.1%)；5例复发(13.9%)，3例在门诊内窥镜下分次摘除并结合YAG激光治愈，2例再次于鼻内镜结合Caidwell-Luc手术治疗，无恶变病例，结论：根据病变范围选择适当的手术方式，经鼻内镜手术切除鼻腔鼻窦内翻性乳头状瘤效果良好。

Application of Nasal Endoscope after Dacryocystorhinostomy

目的:探讨鼻内窥镜在泪囊鼻腔吻合术后的应用。方法:343例436眼实施泪囊鼻腔吻合术,术后结合鼻内窥镜检查。结果:术后随访1～12月,手术治愈好转率为96.33%。结论:鼻内窥镜对泪囊鼻腔吻合术后吻合口行检查及修复,能很好的提高泪囊鼻腔吻合术成功率。

经口腔吸入及鼻腔给药人体药物代谢动力学研究实施体会

经口腔吸入及鼻腔给药的药物制剂日趋增多，通常具有血药浓度低，容易发生沾染，药物吸收入血迅速等特点，根据口、鼻腔给药的特点及影响因素，确保给药剂量的标准化，防止药物沾染是实现此类方式给药的重要问题。结合工作实践，现就经口、鼻腔给药制剂人体药物代谢动力学研究过程中的注意事项予以讨论交流，以供参考。

鼻腔嗅神经母细胞瘤误诊一例

Diagnosis and Treatment of Extranodal Rosai-Dorfman Disease in Nasal Cavity and Nasopharynx

ObjectiveTo investigate the clinical manifestations, diagnosis, treatment and prognosis of Rosai-Dorfman disease (RDD) in nasal cavity and nasopharynx. MethodsWe retrospectively analyzed the clinical data of 4 patients with extranodal RDD admitted to the Department of Otolaryngology, Head and Neck Surgery of our hospital between November 2009 and August 2013. ResultsAll patients received complete surgical removal of the lesions. Histopathological examination showed that large histocytes had an abundant foamy cytoplasm containing ingested lymphocytes as a result of emperipolesis, and were strongly positive for S-100 and CD68 on immunohistochemical analysis, but negative for CD1a. All patients were followed up for 28 to 45 months (averaging 35 months), and no recurrence was observed during the follow-up period. ConclusionRDD is a rare disease, and the exact etiology and pathogenesis of RDD are not fully understood. There is no unified treatment plan recommended, and complete surgical removal of the lesions is an effective method. Minimally invasive surgery may be a good choice for treatment of this disease.

鼻内镜下鼻腔扩容术综合治疗鼻源性头痛60例

目的探讨鼻内镜下鼻腔扩容术综合治疗鼻源性头痛患者的疗效。 方法选取 2011 年 3 月—2012 年 3 月就诊的 60 例鼻源性头痛患者，其中单纯性头痛不伴鼻塞、流涕等鼻部症状者 25 例，头痛伴有鼻塞者 25 例，头痛伴鼻塞、有流脓涕者 10 例；头痛部位多位于前额部、鼻根部、太阳穴处及眶部，多为钝痛或头部昏沉感。所有患者均经鼻内镜检查及鼻窦冠位 CT 扫描检查诊断为鼻腔结构异常和（或）鼻腔、鼻窦炎性病变。根据不同病变，选择性采取相应的鼻腔扩容术，并进行术后综合治疗。术后定期随访 3～12 个月，参照中华医学会耳鼻咽喉科学分会、中华耳鼻咽喉科杂志编委会 1997 年制定的慢性鼻窦炎鼻息肉临床分型分期内镜鼻窦手术疗效评定标准评定治疗效果。 结果60 例患者于术后随访 3～12 个月。治愈 40 例（66.7 %），好转 18 例（30.0%），无效 2 例（3.3%），总有效率为 96.7%。60 例患者均未见鼻中隔穿孔、血肿、外鼻塌陷或畸形，未发生眶眼并发症、颅脑并发症等严重并发症。 结论采用鼻内镜下鼻腔扩容术对于鼻源性头痛患者疗效显著，在手术成功的基础上结合综合治疗及加强术后随访是提高有效率的关键。

清醒志愿者被经口鼻腔吸痰的心理体验

目的 深入了解清醒志愿者被吸痰期间的心理体验，为临床护理人员采取针对性的护理措施提供依据。 方法 2016 年 3 月 12 日，采用自我体验加质性研究方法，研究者及7名学生作为志愿者亲自体验被吸痰的过程，吸痰后对 8 名志愿者进行深入访谈，采用 Colaizzi 分析法进行资料分析。 结果 经口鼻腔吸痰的心理体验包括：被吸痰前的期望体验和对被吸痰的恐惧，被吸痰时极度不舒适，被吸痰后体会到该如何体贴爱护患者。 结论 针对清醒患者的吸痰，护士应该更多地给予安慰和鼓励，重视患者和家属的心理支持，采用多种措施减少负性体验；采用体验式教学可增加护生的爱伤意识。